More than three quarters of new non-cancer pain opioids prescribed by UK GPs are for musculoskeletal conditions, despite limited evidence of efficacy, a large study has found.
An analysis of more than two million GP patient records between 2006 and 2021 found that 80.8% of prescriptions were for musculoskeletal pain with the most frequent conditions being osteoarthritis and lower back pain.
Of the patients who had been prescribed opioids for non-cancer pain, 61% were women and 77% were aged over 45, the study published in the journal Pain. Almost half of patients were from the highest deprivation quintile.
But the team also discovered a pattern of opioid use for respiratory conditions such as cough, infections, trauma and injuries such as sprains and strains, neurological issues such as headaches, and post-surgical pain.
The most common surgical indications were total knee and hip replacements, followed by hernia repairs, they said.
Commenting on the findings, the researchers said recommendations including from NICE, suggested alternatives unless other forms of pain relief are contraindicated.
This includes guidance that no longer recommends for osteoarthritis or chronic low back pain.
Other research had shown a 48.9% increase in opioid-related hospitalisations from 2008 to 2018.
In 2021, opioids were involved in nearly half (2,219) of all UK drug poisoning deaths, they added.
Although more recent NHS figures have suggested GPs were prescribing fewer potentially addictive drugs including opioids.
There has been renewed focus on the issue after a government-commissioned review in 2019 reported more than 11 million adults in England were prescribed addictive drugs. But that also found that opioid prescriptions for chronic pain had started to decline.
GPs have said they need better options to support patients who are addicted to painkillers.
Study author Carlos Ramirez Medina, research associate in the School of Biological Sciences at the University of Manchester, said: ‘While our study does not aim to evaluate the appropriateness of opioid prescriptions, it uses nationally representative data to increase awareness of the possible reasons for opioid initiation in UK primary care and encourage a re-evaluation of prescribing practices.’
Co-author Dr Meghna Jani, a consultant rheumatologist at Salford Royal Hospital, added: ‘Our study indicates that opioids are commonly prescribed in patients with musculoskeletal conditions, despite scientific evidence suggesting limited effectiveness, especially in conditions such as osteoarthritis.
‘For chronic lower back pain and osteoarthritis in particular, the ongoing prescription of opioids may suggest a complex landscape of pain management given limited drug treatment options for these conditions and access to helpful interventions such as physiotherapy.’
She added the increasing proportion of opioid use in musculoskeletal conditions over time may also be reflective of an aging population.
‘We hope these findings will help inform targeted interventions in specific disease areas and future policies to support non-pharmacological interventions in the most common conditions where opioid associated harms outweigh benefits.’
I started GP around 35 years ago. Where were the constant stream of chronic pain and MUS patients then? Were they not seen? Did they not present? I’ve been doing this job long enough to see long term trends and this one fascinates me. Fibromyalgia? One per month. Now it’s one per hour. NEAs? A fascinating and unusual case in the 1990s. I can name a current 5 in my small practice. Bed bound kids with CFS and unexplained funny turns? Loads. Pain clinics? 2 years wait for a service that didn’t exist 30 years ago. Don’t misunderstand i’m good with these patients. But what’s going on?